We propose to extend our current health literacy investigation ['LitCog'; R01AG030611] and evaluate the association between literacy skills, cognitive function, and health outcomes over time among an established cohort of community-dwelling, older adults. An increasing number of investigators are questioning whether cognitive function might explain why adults with low 'health literacy' experience poorer health. Our team is currently conducting an NIA-funded, cross-sectional study, Health Literacy and Cognitive Function among Older Adults (a.k.a. 'LitCog'). The objective is to investigate the relationship between health literacy and cognitive function, and to determine how these factors predict performance on common health tasks. We now propose to follow-up LitCog participants (N=1100) and examine the association between literacy, cognitive function, performance on common health tasks, and health status over a 5-year period. A longitudinal study will provide an in-depth investigation of older adults' health literacy skills, and how their ability to manage health is affected by cognitive decline and the aging process. The proposed cohort study will improve our understanding of: 1) the true barriers underlying the problem of low health literacy, and 2) how best to inform present and future intervention strategies. Our primary study aims are to: 1) Determine whether older adults' health literacy skills change over time, and if these changes are associated with a decline in cognitive function; 2) Evaluate the association between health literacy, cognitive function, and health status among older adults; 3) Investigate psychosocial factors that potentially mediate or moderate the association between literacy skills, cognitive function, and health status among older adults; and our secondary aim is to: 4) Explore strategies to enhance older adults' performance on health tasks that mostly rely on fluid cognitive abilities. We will conduct follow-up interviews (T2 - 2.5 years; T3 - 5 years post-baseline interview) with older adults who previously participated in the LitCog study; administering the same health literacy, cognitive function, and health status measures given in the baseline battery. In Aim 4, we will embed a series of controlled, cross-sectional experiments to test specific strategies to increase older adults' performance on complex health tasks. PUBLIC HEALTH RELEVANCE: The extent and association between limited literacy and poor health outcomes has been repeatedly documented, yet specific causal pathways are not entirely clear. The proposed longitudinal study will provide an in-depth investigation of older adults' health literacy and ability to manage health, and whether these skills are affected by cognitive decline and the aging process. Our research will improve our understanding of the true barriers underlying the problem of low health literacy, and how best to inform present and future intervention strategies.